Provider Demographics
NPI:1245394097
Name:DEGOOYER, KERRY H (DC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:H
Last Name:DEGOOYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SUMMITVIEW AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3023
Mailing Address - Country:US
Mailing Address - Phone:509-452-8349
Mailing Address - Fax:
Practice Address - Street 1:1001 SUMMITVIEW AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3023
Practice Address - Country:US
Practice Address - Phone:509-452-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02058Medicare UPIN
WA0119077Medicare PIN